tbuckley/cabot-search huggingface dataset:
Risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a comprehensive systematic review and meta-analysis
Authors: Shangnan Dai, Yunpeng Peng, Guangfu Wang, Lingdi Yin, Han Yan, Chunhua Xi, Feng Guo, Jianmin Chen, Min Tu, Zipeng Lu, Jishu Wei, Wentao Gao, Kuirong Jiang, Junli Wu, Yi Miao
Journal: International Journal of Surgery (2023)

Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD). However, its risk factors are still unclear. This meta-analysis aimed to identify the potential risk factors of DGE among patients undergoing PD or PPPD.We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrial.gov for studies that examined the clinical risk factors of DGE after PD or PPPD from inception through 31 July 2022. We pooled odds ratios (ORs) with 95% CIs using random-effects or fixed-effects models. We also performed heterogeneity, sensitivity, and publication bias analyses.The study included a total of 31 research studies, which involved 9205 patients. The pooled analysis indicated that out of 16 nonsurgical-related risk factors, three risk factors were found to be associated with an increased incidence of DGE. These risk factors were older age (OR 1.37, P =0.005), preoperative biliary drainage (OR 1.34, P =0.006), and soft pancreas texture (OR 1.23, P =0.04). On the other hand, patients with dilated pancreatic duct (OR 0.59, P =0.005) had a decreased risk of DGE. Among 12 operation-related risk factors, more blood loss (OR 1.33, P =0.01), postoperative pancreatic fistula (POPF) (OR 2.09, P <0.001), intra-abdominal collection (OR 3.58, P =0.001), and intra-abdominal abscess (OR 3.06, P <0.0001) were more likely to cause DGE. However, our data also revealed 20 factors did not support stimulative factors influencing DGE.Age, preoperative biliary drainage, pancreas texture, pancreatic duct size, blood loss, POPF, intra-abdominal collection, and intra-abdominal abscess are significantly associated with DGE. This meta-analysis may have utility in guiding clinical practice for improvements in screening patients with a high risk of DGE and selecting appropriate treatment measures.
Racial Disparities Among Lung Transplant Survivors—Shadows and Substance
Authors: Ayodeji Adegunsoye, Milda R. Saunders
Journal: JAMA Network Open (2023)

Carli J. Lehr, MD, PhD; Maryam Valapour, MD, MPP; Paul R. Gunsalus, MS; Warren T. McKinney, PhD; Kristen A. Berg, PhD; Johnie Rose, MD, PhD; Jarrod E. Dalton, PhD
Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study
Authors: Qingtong Zhang, Feng Xu, Dongsheng Xuan, Li Huang, Min Shi, Zichuan Yue, Dongxue Luo, Manlin Duan
Journal: International Journal of Surgery (2023)

Background: Delayed recovery in the postanesthesia care unit (PACU) after surgery, as a severe occurrence, influences enhanced recovery after surgery. The data from the observational clinical study is a paucity. Materials and Methods: This large, retrospective, and observational cohort study initially included 44 767 patients. The primary outcome was risk factors for delayed recovery in PACU. A generalized linear model and nomogram were employed to identify risk factors. Discrimination and calibration were used to evaluate the performance of the nomogram via internal and external validation. Results: Of 38 796 patients, 21 302 (54.91%) were women. The delayed recovery aggregate rate was 1.38% [95% CI, (1.27, 1.50%)]. In a generalized linear model, risk factors for delayed recovery were old age [RR, 1.04, 95% CI, (1.03,1.05), P &lt;0.001], neurosurgery [RR, 2.75, 95% CI, (1.60, 4.72), P &lt;0.001], using antibiotics during surgery [RR, 1.30, 95% CI, (1.02, 1.66), P =0.036], long anesthesia duration [RR, 1.0025, 95% CI, (1.0013, 1.0038), P &lt;0.001], ASA grade of III [RR, 1.98, 95% CI, (1.38, 2.83), P &lt;0.001], and postoperative analgesia [RR, 1.41, 95% CI, (1.10, 1.80), P =0.006]. In the nomogram, old age and neurosurgery had high scores in the model and contributed significantly to the increased probability of delayed recovery. The area under the curve value of the nomogram was 0.77. The discrimination and calibration of the nomogram estimated by internal and external validation were generally satisfactory. Conclusion: This study demonstrates that delayed recovery in PACU after surgery was associated with old age, neurosurgery, long anesthesia duration, an ASA grade of III, using antibiotics during surgery, and postoperative analgesia. These findings provide predictors of delayed recovery in PACU, especially neurosurgeries and old age.
Association between prehospital end-tidal carbon dioxide levels and mortality in patients with suspected severe traumatic brain injury
Authors: Sebastiaan M. Bossers, Floor Mansvelder, Stephan A. Loer, Christa Boer, Frank W. Bloemers, Esther M. M. Van Lieshout, Dennis Den Hartog, Nico Hoogerwerf, Joukje van der Naalt, Anthony R. Absalom, Lothar A. Schwarte, Jos W. R. Twisk, Patrick Schober, Anne de Boer, Johannes C. Goslings, Sven H. van Helden, Danique Hesselink, Gijs van Aken, Albertus Beishuizen, Rolf E. Egberink, Nancy ter Bogt, Mariska A. C. de Jongh, Koen Lansink, Koen Lansink, Gerwin Roks, Pieter Joosse, Kees J. Ponsen, Lukas L. van Spengler, Stasja Asper, Saskia M. Peerdeman, Robert J. Houmes, Jan van Ditshuizen, Tea van Voorden, Michael J. R. Edwards, Bert Dercksen, Rob Spanjersberg, Lieneke Venema, Ellen Weelink, Inge H. F. Reininga, Gerard Innemee, Matthijs de Visser, Marcel A. de Leeuw, Fabian O. Kooij
Journal: Intensive Care Medicine (2023)

Severe traumatic brain injury is a leading cause of mortality and morbidity, and these patients are frequently intubated in the prehospital setting. Cerebral perfusion and intracranial pressure are influenced by the arterial partial pressure of CO2 and derangements might induce further brain damage. We investigated which lower and upper limits of prehospital end-tidal CO2 levels are associated with increased mortality in patients with severe traumatic brain injury. The BRAIN-PROTECT study is an observational multicenter study. Patients with severe traumatic brain injury, treated by Dutch Helicopter Emergency Medical Services between February 2012 and December 2017, were included. Follow-up continued for 1 year after inclusion. End-tidal CO2 levels were measured during prehospital care and their association with 30-day mortality was analyzed with multivariable logistic regression. A total of 1776 patients were eligible for analysis. An L-shaped association between end-tidal CO2 levels and 30-day mortality was observed (p = 0.01), with a sharp increase in mortality with values below 35 mmHg. End-tidal CO2 values between 35 and 45 mmHg were associated with better survival rates compared to < 35 mmHg. No association between hypercapnia and mortality was observed. The odds ratio for the association between hypocapnia (< 35 mmHg) and mortality was 1.89 (95% CI 1.53–2.34, p < 0.001) and for hypercapnia (≥ 45 mmHg) 0.83 (0.62–1.11, p = 0.212). A safe zone of 35–45 mmHg for end-tidal CO2 guidance seems reasonable during prehospital care. Particularly, end-tidal partial pressures of less than 35 mmHg were associated with a significantly increased mortality.
Reasons for Surgical Trainee Burnout in the United Kingdom
Authors: Angelos Mantelakis, Hugo Layard Horsfall
Journal: JAMA Surgery (2023)

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Emergency surgery in the era of artificial intelligence: ChatGPT could be the doctor’s right-hand man
Authors: Kunming Cheng, Zhiyong Li, Qiang Guo, Zaijie Sun, Haiyang Wu, Cheng Li
Journal: International Journal of Surgery (2023)

Cheng, Kunming; Li, Zhiyong; Guo, Qiang; Sun, Zaijie; Wu, Haiyang; Li, Cheng Author Information
Peripheral blood cells vacuoles in <scp>VEXAS</scp> syndrome
Authors: Francesca Tosato, Michela Pelloso, Jenny Zuin, Daniela Basso
Journal: American Journal of Hematology (2023)

The authors do not have any commercial or other association that might pose a conflict of interest. The data that support the findings of this study are available from the corresponding author, FT, upon reasonable request.
Dupilumab improves long‐term outcomes in patients with uncontrolled, <scp>moderate‐to‐severe GINA‐based</scp> type 2 asthma, irrespective of allergic status
Authors: Klaus F. Rabe, Ian D. Pavord, William W. Busse, Geoffrey L. Chupp, Kenji Izuhara, Arman Altincatal, Rebecca Gall, Nami Pandit‐Abid, Yamo Deniz, Paul J. Rowe, Juby A. Jacob‐Nara, Amr Radwan
Journal: Allergy (2023)

Previous research has shown greater efficacy of dupilumab in patients with uncontrolled asthma and type 2 inflammation. We analyzed dupilumab's efficacy in patients from the TRAVERSE study with or without evidence of allergic asthma and type 2 inflammation per current GINA guidelines (≥150 eosinophils/μL or FeNO ≥20 ppb).All patients aged ≥12 years who rolled over from the placebo-controlled QUEST study (NCT02414854) to TRAVERSE (NCT02134028) received add-on dupilumab 300 mg every 2 weeks for up to 96 weeks. We assessed annualized severe asthma exacerbation rates (AERs) and changes from parent-study baseline (PSBL) in pre-bronchodilator FEV1 and 5-item asthma control questionnaire (ACQ-5) score in patients with moderate-to-severe type 2 asthma with and without evidence of allergic asthma at PSBL.In TRAVERSE, dupilumab consistently reduced AER across all subgroups. By Week 96, dupilumab increased pre-bronchodilator FEV1 from PSBL by 0.35-0.41 L in patients receiving placebo during QUEST (placebo/dupilumab) and 0.34-0.44 L in those receiving dupilumab during QUEST (dupilumab/dupilumab) with an allergic phenotype at baseline. In patients without evidence of allergic asthma, pre-bronchodilator FEV1 improved by 0.38-0.41 L and 0.33-0.37 L, respectively. By Week 48, ACQ-5 scores decreased from PSBL by 1.63-1.69 (placebo/dupilumab) and 1.74-1.81 (dupilumab/dupilumab) points across subgroups with allergic asthma, and 1.75-1.83 (placebo/dupilumab) and 1.78-1.86 (dupilumab/dupilumab) in those without.Long-term treatment with dupilumab reduced exacerbation rates and improved lung function and asthma control in patients with asthma with type 2 inflammation as per current GINA guidance and irrespective of evidence of allergic asthma.
Use of HBV RNA and to predict change in serological status and disease activity in CHB
Authors: Marc G. Ghany, Wendy C. King, Amanda S. Hinerman, Anna SF. Lok, Mauricio Lisker-Melman, Raymond T. Chung, Norah Terrault, Harry L.A. Janssen, Mandana Khalili, William M. Lee, Daryl T.Y. Lau, Gavin A. Cloherty, Richard K. Sterling
Journal: Hepatology (2023)

Background and Aims: Predicting changes in disease activity and serological endpoints is necessary for the management of patients with chronic hepatitis B (CHB). We examined whether HBV RNA and hepatitis B core-related antigen (HBcrAg), two specialized virological markers proposed to reflect the activity of covalently closed circular DNA, may improve the ability to predict not sustained inactive carrier phase, spontaneous alanine aminotransferase (ALT) flare, HBeAg loss, and HBsAg loss. Approach and Results: Among eligible participants enrolled in the North American Hepatitis B Research Network Adult Cohort Study, we evaluated demographic, clinical, and virologic characteristics, including HBV RNA and HBcrAg, to predict not sustained inactive carrier phase, ALT flare, HBeAg loss, and HBsAg loss through a series of Cox proportional hazard or logistic regression models, controlling for antiviral therapy use. Among the study population, 54/103 participants experienced not sustained inactive carrier phase, 41/1006 had a spontaneous ALT flare, 83/250 lost HBeAg, and 54/1127 lost HBsAg. HBV RNA or HBcrAg were predictive of all 4 events. However, their addition to models of the readily available host (age, sex, race/ethnicity), clinical (ALT, use of antiviral therapy), and viral factors (HBV DNA), which had acceptable-excellent accuracy (e.g., AUC = 0.72 for ALT flare, 0.92 for HBeAg loss, and 0.91 for HBsAg loss), provided only small improvements in predictive ability. Conclusion: Given the high predictive ability of readily available markers, HBcrAg and HBV RNA have a limited role in improving the prediction of key serologic and clinical events in patients with CHB.
LOGGIC Core BioClinical Data Bank: Added clinical value of RNA-Seq in an international molecular diagnostic registry for pediatric low-grade glioma patients
Authors: Emily C Hardin, Simone Schmid, Alexander Sommerkamp, Carina Bodden, Anna-Elisa Heipertz, Philipp Sievers, Andrea Wittmann, Till Milde, Stefan M Pfister, Andreas von Deimling, Svea Horn, Nina A Herz, Michèle Simon, Ashwyn A Perera, Amedeo Azizi, Ofelia Cruz, Sarah Curry, An Van Damme, Miklos Garami, Darren Hargrave, Antonis Kattamis, Barbara Faganel Kotnik, Päivi Lähteenmäki, Katrin Scheinemann, Antoinette Y N Schouten-van Meeteren, Astrid Sehested, Elisabetta Viscardi, Ole Mikal Wormdal, Michal Zapotocky, David S Ziegler, Arend Koch, Pablo Hernáiz Driever, Olaf Witt, David Capper, Felix Sahm, David T W Jones, Cornelis M van Tilburg
Journal: Neuro-Oncology (2023)

Abstract Background The international, multicenter registry LOGGIC Core BioClinical Data Bank aims to enhance the understanding of tumor biology in pediatric low-grade glioma (pLGG) and provide clinical and molecular data to support treatment decisions and interventional trial participation. Hence, the question arises whether implementation of RNA sequencing (RNA-Seq) using fresh frozen (FrFr) tumor tissue in addition to gene panel and DNA methylation analysis improves diagnostic accuracy and provides additional clinical benefit. Methods Analysis of patients aged 0 to 21 years, enrolled in Germany between April 2019 and February 2021, and for whom FrFr tissue was available. Central reference histopathology, immunohistochemistry, 850k DNA methylation analysis, gene panel sequencing, and RNA-Seq were performed. Results FrFr tissue was available in 178/379 enrolled cases. RNA-Seq was performed on 125 of these samples. We confirmed KIAA1549::BRAF-fusion (n = 71), BRAF V600E-mutation (n = 12), and alterations in FGFR1 (n = 14) as the most frequent alterations, among other common molecular drivers (n = 12). N = 16 cases (13%) presented rare gene fusions (eg, TPM3::NTRK1, EWSR1::VGLL1, SH3PXD2A::HTRA1, PDGFB::LRP1, GOPC::ROS1). In n = 27 cases (22%), RNA-Seq detected a driver alteration not otherwise identified (22/27 actionable). The rate of driver alteration detection was hereby increased from 75% to 97%. Furthermore, FGFR1 internal tandem duplications (n = 6) were only detected by RNA-Seq using current bioinformatics pipelines, leading to a change in analysis protocols. Conclusions The addition of RNA-Seq to current diagnostic methods improves diagnostic accuracy, making precision oncology treatments (MEKi/RAFi/ERKi/NTRKi/FGFRi/ROSi) more accessible. We propose to include RNA-Seq as part of routine diagnostics for all pLGG patients, especially when no common pLGG alteration was identified.
Engineering Neurovascular Unit and Blood–Brain Barrier for Ischemic Stroke Modeling
Authors: Ze Liu, Yaohui Tang, Zhijun Zhang, Qianqian Liu, Mian Wang, Wanlu Li, Guo‐Yuan Yang
Journal: Advanced Healthcare Materials (2023)

Abstract Ischemic stroke is a primary vascular disease of the central nervous system characterized by high morbidity, mortality, and healthcare costs. As conventional ischemic stroke models fail to predict therapeutic efficacy, in vitro neurovascular unit (NVU)/blood–brain barrier (BBB) models are utilized to model ischemic stroke through replicating the cell–cell interactions and mimicking the blood flow and anatomical features of the brain. Here, an overview of transwell, microfluidic, and hydrogel‐based NVU/BBB models is provided, including cell types, engineering approaches, and the simulation of physiological and pathological features of NVU/BBB after ischemic stroke. Collectively, recent advances in 3D‐printed NVU models are emphasized, which are anticipated to be a promising system for more reliable mechanistic studies and preclinical drug screenings that can eventually accelerate the drug development process for the ischemic stroke therapy.
Case 12-2023: A 44-Year-Old Woman with Muscle Weakness and Myalgia
Authors: Marcy B. Bolster, Alexis M. Cahalane, Steven K. Grinspoon, Eli M. Miloslavsky
Journal: New England Journal of Medicine (2023)

A 44-year-old woman with rheumatoid arthritis was evaluated because of proximal muscle weakness and myalgia. She had difficulty raising her arms above her head. Diagnostic tests were performed.
Burden of Typhoid and Paratyphoid Fever in India
Authors: Jacob John, Ashish Bavdekar, Temsunaro Rongsen-Chandola, Shanta Dutta, Madhu Gupta, Suman Kanungo, Bireshwar Sinha, Manikandan Srinivasan, Ankita Shrivastava, Adarsh Bansal, Ashita Singh, Roshine M. Koshy, Dasharatha R. Jinka, Mathew S. Thomas, Anna P. Alexander, Shajin Thankaraj, Sheena E. Ebenezer, Arun S. Karthikeyan, Dilesh Kumar, Swathi K. Njarekkattuvalappil, Reshma Raju, Nikhil Sahai, Balaji Veeraraghavan, Manoj V. Murhekar, Venkata R. Mohan, Sindhu K. Natarajan, Karthikeyan Ramanujam, Prasanna Samuel, Nathan C. Lo, Jason Andrews, Nicholas C. Grassly, Gagandeep Kang
Journal: New England Journal of Medicine (2023)

In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection.
Enteric Fever — Tools for Prevention
Authors: Kathleen M. Neuzil
Journal: New England Journal of Medicine (2023)

Typhoid and paratyphoid fever are acquired through consumption of water or food contaminated by the feces of an infected or colonized person. Although improvements in sewage disposal and the provision of safe drinking water eliminated enteric fever in much of the industrialized world by the early 20th century, typhoid and paratyphoid fever remain endemic in impoverished regions of Asia, Africa, and Oceania. Estimating the burden of these diseases is challenging, given their nonspecific clinical presentation and the lack of blood-culture surveillance in much of the world. In this issue of the Journal, John et al.1 report the results of a . . .
Role of Preoperative Hepatobiliary Scintigraphy in Children Requiring Liver Resection
Authors: Kailash Chaurasiya, Elena Kireeva, Mikhail Yadgarov, Dmitry Akhaladze, Yury Likar
Journal: Clinical Nuclear Medicine (2023)

The risk of posthepatectomy liver failure (PHLF) remains an important concern following major liver resection. Assessment of future remnant liver function (FRLF) by hepatobiliary scintigraphy has shown its significance to prevent PHLF after major liver resection in adults with a threshold value of FRLF greater than 2.7%/min per m2. However, such data for pediatric patients were not published.A total of 77 pediatric patients with liver tumors who underwent 1-stage liver resection were included in this study. Assessment of FRLF, future remnant liver volume (FRLV), and the ratio of remnant liver volume to body weight (RLV-BWR) was performed before the surgery.All patients had RLV-BWR values of more than 0.5%/kg. Future remnant liver volume values ranged from 19% to 89%, and FRLF values ranged from 1.8% to 31.8%/min per m2. Only 7 of 77 patients had FRLV values less than 25%, but their FRLF values exceeded 2.7%/min per m2. Two patients developed grade A and grade B PHLF.Future remnant liver volume and the RLV-BWR can be used in most pediatric patients for the assessment of liver before hepatectomy. According to our data, implementation of FRLF assessment using hepatobiliary scintigraphy can be most beneficial for children with FRLV of less than 25%. The cutoff value of FRLV greater than 25% can be slightly decreased with minimal risk of developing PHLF. However, to establish a new cutoff value for FRLV in children, further prospective studies including larger numbers of patients with FRLV of less than 25% are needed.
68Ga-FAPI-04 PET/MR Versus 18F-FDG PET/CT in the Detection of Ovarian Cancer
Authors: Gaofeng Sun, Ruoyao Zou, Liangqing Yao, Changjing Zuo
Journal: Clinical Nuclear Medicine (2023)

A 75-year-old woman presented with right lower abdominal pain. Pelvic ultrasound showed a cystic solid mass in the right adnexa. Painless enlarged lymph nodes on the left supraclavicular side with biopsy were suggestive of metastatic cancer. 18F-FDG PET/CT performed to evaluate the primary tumor showed intense uptake in both regions of the right adnexa and the gastric sinus, but 68Ga-FAPI PET/MRI showed uptake only in the right adnexal region. A subsequent gastroscopic biopsy confirmed atrophic inflammation. Finally, surgery histopathology revealed ovarian cancer. This case demonstrated that 68Ga-FAPI PET/MRI may help exclude suspected primary gastric carcinoma with false-positive 18F-FDG uptake.
Intervening on Social Determinants for Better Outcomes in Pediatric Tuberculosis Management
Authors: Carlos Podalirio Borges de Almeida, Carole Diane Mitnick
Journal: American Journal of Respiratory and Critical Care Medicine (2023)

"Intervening on Social Determinants for Better Outcomes in Pediatric Tuberculosis Management ." American Journal of Respiratory and Critical Care Medicine, 0(ja), pp. –
Malignant Melanoma of the External Auditory Canal on 68Ga-FAPI PET/CT
Authors: Ya Liu, Haoyuan Ding, Zibei Wan, Dongmei Fan, Zhanwen Huang
Journal: Clinical Nuclear Medicine (2023)

External ear melanomas are relatively rare and usually occur in the regions of helix and ear lobes. Rarer still are primary melanomas of the external auditory canal. We report findings of melanoma of the external auditory canal on 68 Ga-FAPI PET/CT in a 56-year-old man who presented with sharp pain in the external auditory canal for 7 months.
FAPI PET Positivity in Fibrolamellar Hepatocellular Carcinoma
Authors: Ritesh Ramesh Suthar, Nilendu Purandare, Sneha Shah, Archi Agrawal, Ameya Puranik, Venkatesh Rangarajan
Journal: Clinical Nuclear Medicine (2023)

Abstract Fibrolamellar hepatocellular carcinoma (HCC) is a variant of HCC. It is a malignant tumor, but its imaging features often overlap focal nodular hyperplasia, which is a benign entity. FDG PET/CT is also not much help in these cases because both lesions do not concentrate FDG. We present one such case of fibrolamellar HCC with FAPI PET/CT positivity.